Adagrasib: a novel inhibitor for KRASG12C-mutated non-small-cell lung cancer

KRAS-G12 inhibitors in lung cancer therapy: unveiling the toxicity profile through a pharmacovigilance study

BACKGROUND

With the advent of drugs designed to selectively target the KRAS-G12C mutant protein, sotorasib and adagrasib have exhibited remarkable efficacy in patients with KRAS G12C mutant lung cancers. Nevertheless, the safety profiles of these agents in a real-world context remain undisclosed.

METHODS

Data was systematically extracted from the FDA Adverse Event Reporting System (FAERS) website from January 2021 to December 2023, focusing on adverse events associated with KRAS G12C inhibitors, sotorasib and adagrasib.

RESULTS

The predominant adverse events attributed to KRAS G12C inhibitors predominantly encompassed general disorders and administration site conditions, investigations, and gastrointestinal disorders. Among these, the significant adagrasib-related adverse events comprised nausea, diarrhea, vomiting, asthenia, dizziness, and weight loss. Notably, incidences of renal failure were also documented in patients receiving adagrasib. Conversely, the primary adverse events associated with sotorasib included diarrhea, nausea, abnormal hepatic function, elevated levels of aspartate aminotransferase and alanine aminotransferase, and hepatotoxicity. It is noteworthy that a considerable number of adverse events manifested within the inaugural month following the initiation of therapy with KRAS G12C inhibitors.

CONCLUSION

Although most adverse effects are reversible, vigilance is warranted particularly for nephrotoxicity and hepatotoxicity during the administration of KRAS G12C inhibitors.

Plunging Into the PACIFIC: Outcomes of Patients With Unresectable KRAS-Mutated Non-Small Cell Lung Cancer Following Definitive Chemoradiation and Durvalumab Consolidation

BACKGROUND

Immune checkpoint inhibitor (ICI) consolidation following concurrent chemoradiotherapy (CRT) substantially improved progression free survival (PFS) and overall survival (OS) in the PACIFIC trial becoming the standard of care in locally-advanced, unresectable NSCLC. KRAS mutation may influence response to ICI.

METHODS

In this single-institution, retrospective analysis, we compared treatment outcomes for patients with unresectable KRAS mutated (KRAS-mt) and wild-type (KRAS-wt) NSCLC treated with CRT between October 2017 and December 2021. Kaplan-Meier analysis was conducted comparing median progression free survival and median overall survival from completion of radiotherapy in all KRAS-mt patients and KRAS-G12C-mutated patients. Outcomes were also compared with and without ICI consolidation.

RESULTS

Of 156 patients, 42 (26.9%) were KRAS-mt and 114 (73.1%) were KRAS-wt. Baseline characteristics differed only in histology; KRAS-mt NSCLC more likely to be adenocarcinoma. KRAS-mt patients had worse PFS (median 6.3 vs. 10.7 months, P = .041) but similar OS (median 23.1 vs. 27.3 months, P = .237). KRAS-mt patients were more likely to not receive ICI due to rapid disease progression post-CRT (23.8% vs. 4.4%, P = .007). Among patients who received ICI (n = 114), KRAS-mt was not associated with inferior PFS (8.1 vs. 11.9 months, P = .355) or OS (30.5 vs. 31.7 months, P = .692). KRAS-G12C patients (n = 22) had similar PFS and OS to other KRAS-mt.

CONCLUSION

In one of the largest post-CRT KRAS-mt cohort published, KRAS-mt was associated with inferior PFS, largely due to rapid progression prior to ICI consolidation, but did not affect OS. Among those who received ICI consolidation, outcomes were comparable regardless of KRAS-mt status.

Strategic Insight into the Combination Therapies for Metastatic Colorectal Cancer

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. The 5-year survival rate after curative resection is almost 80%, however, it is still less than satisfactory for metastatic CRC (mCRC). The combination approach including surgery, chemotherapy, molecular targeted therapy, and immunotherapy is a promising strategy due to its synergistic anticancer effect. Moreover, circulating tumor DNA (ctDNA) analysis has been reported to stratify the post-operative risk of recurrence, thus providing clinically valuable information for deciding to conduct adjuvant chemotherapy. Furthermore, multiple new drugs that potentially target undruggable genes, including KRAS, have been developed. In this review, we discuss the current management of patients with mCRC and future perspectives in the light of a combination therapeutic strategy.